Healthcare Provider Details

I. General information

NPI: 1073803144
Provider Name (Legal Business Name): SUMMER D MOWRY ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DR SUITE 108
SCARBOROUGH ME
04074-7171
US

IV. Provider business mailing address

PO BOX 911
BRATTLEBORO VT
05302-0911
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7600
  • Fax: 207-396-7610
Mailing address:
  • Phone: 207-396-7601
  • Fax: 207-396-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR200997-3
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP131126
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP131126
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: